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Get PA Medical Command Authorization Form 2002-2024

Department EMT-P / PHRN / HP #:___________________ Name of ALS Service:_____________________________ 1. List all ambulance services with which you have had medical command authorization in the past five years. If necessary, please use a separate sheet of paper. Name of Service________________________________ Dates with Service_______________________________ ALS Service Medical Director______________________ Telephone Number______________________________ Name of Service_________________________.

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